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Javeed S, Benedict B, Yakdan S, Saleem S, Zhang JK, Botterbush K, Frumkin MR, Hardi A, Neuman B, Kelly MP, Steinmetz MP, Piccirillo JF, Goodin BR, Rodebaugh TL, Ray WZ, Greenberg JK. Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2348565. [PMID: 38277149 PMCID: PMC10818221 DOI: 10.1001/jamanetworkopen.2023.48565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Comorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive. Objective To investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery. Data Sources A systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023. Study Selection Included studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included. Data Extraction and Synthesis All data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity. Main Outcomes and Measures The primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations. Results Of the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, -0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, -0.52 [95% CI, -0.62 to -0.41]; I2 = 89%; P < .001), which remained worse postoperatively (SMD, -0.52 [95% CI, -0.75 to -0.28]; I2 = 98%; P < .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance. Conclusions and Relevance Results of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.
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Affiliation(s)
- Saad Javeed
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Salim Yakdan
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Samia Saleem
- Department of Musculoskeletal Research, Washington University, St Louis, Missouri
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Kathleen Botterbush
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Madelyn R. Frumkin
- Department of Psychology and Brain Sciences, Washington University, St Louis, Missouri
| | - Angela Hardi
- Becker Medical Library, Washington University, St Louis, Missouri
| | - Brian Neuman
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri
| | - Michael P. Kelly
- Department of Orthopedic Surgery, Rady Children’s Hospital, University of California, San Diego, San Diego
| | | | - Jay F. Piccirillo
- Department of Otolaryngology, Washington University, St Louis, Missouri
| | - Burel R. Goodin
- Department of Anesthesiology, Washington University, St Louis, Missouri
| | - Thomas L. Rodebaugh
- Department of Psychology and Brain Sciences, Washington University, St Louis, Missouri
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St Louis, Missouri
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University, St Louis, Missouri
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
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Patel MR, Jacob KC, Amin KS, Ribot MA, Pawlowski H, Prabhu MC, Vanjani NN, Singh K. Does Baseline Mental Health Influence Outcomes among Workers' Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion? Asian Spine J 2023; 17:96-108. [PMID: 35989505 PMCID: PMC9977979 DOI: 10.31616/asj.2021.0388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This was a retrospective cohort study. PURPOSE This study investigated the influence of preoperative mental health on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) among workers' compensation (WC) recipients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). OVERVIEW OF LITERATURE No studies have evaluated the impact of preoperative mental functioning on outcomes following MIS TLIF among WC claimants. METHODS WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology. RESULTS The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months SF-12 MCS, 12-weeks/6-months VAS back, 12-week VAS leg, and preoperative to 6-months ODI (p≤0.029, all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004). CONCLUSIONS Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1-2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health.
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Affiliation(s)
- Madhav Rajesh Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin Chacko Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kanhai S Amin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Max A Ribot
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Teo BJX, Howe TS, Chan C, Koh JSB, Yeo W, Ng YH. Preoperative Oswestry Disability Index Cannot Reliably Predict Patient Satisfaction After Single and Double Level Lumbar Transforaminal Interbody Fusion Surgery. Geriatr Orthop Surg Rehabil 2023; 14:21514593231152172. [PMID: 36687777 PMCID: PMC9846293 DOI: 10.1177/21514593231152172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction The role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery. Aims To investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction. Methods 1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score. Results At 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 (P < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups. Conclusions Overall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients' satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.
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Affiliation(s)
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - Cheri Chan
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - Joyce SB. Koh
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore
| | - William Yeo
- Orthopaedic Diagnostic Centre, Singapore General
Hospital, Singapore
| | - Yeong Huei Ng
- Department of Orthopaedic Surgery, Singapore General
Hospital, Singapore,Yeong Huei Ng, FRCS, Department of
Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore
169856, Singapore.
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Hartman TJ, Nie JW, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion. J Clin Orthop Trauma 2022; 34:102020. [PMID: 36161064 PMCID: PMC9490096 DOI: 10.1016/j.jcot.2022.102020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 09/07/2022] [Indexed: 10/31/2022] Open
Abstract
Background Mental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population. Methods WC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. Results Depressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all). Conclusion Depressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.
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Affiliation(s)
- Timothy J. Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James W. Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R. MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O. Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
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Patel MR, Jacob KC, Nie JW, Hartman TJ, Vanjani N, Pawlowski H, Prabhu M, Amin KS, Singh K. The Effect of the Preoperative Severity of Neck Pain on Patient-Reported Outcome Measures and Minimum Clinically Important Difference Achievement After Anterior Cervical Discectomy and Fusion. World Neurosurg 2022; 165:e337-e345. [PMID: 35718277 DOI: 10.1016/j.wneu.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measure (PROM) scores and minimum clinically important difference (MCID) achievement rates among patients undergoing single-level anterior cervical discectomy and fusion (ACDF) in patients with varying severity of preoperative visual analog scale (VAS) neck score. METHODS Patients with ACDF were grouped: severity of preoperative VAS neck score ≤8 or >8. Demographic/perioperative variables and PROMs (Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF] score, 12-Item Short Form [SF-12] Mental Component Score [MCS], VAS neck/arm score, and Neck Disability Index [NDI]) were collected preoperatively/postoperatively. MCID attainment comparison by grouping was evaluated using χ2 analysis. RESULTS A total of 137 patients were included (103 VAS neck preoperative score ≤8; 34 VAS neck preoperative score >8). The VAS neck preoperative score ≤8 cohort did not improve: 6 weeks PROMIS-PF score, 6 weeks SF-12 Physical Component Score [PCS], 12 weeks/1 year/2 years SF-12 MCS, 2 years VAS neck score, and 1 years/2 years VAS arm score (P ≤ 0.015, all). VAS neck preoperative score >8 did not improve: 6 weeks/12 weeks/2 years PROMIS-PF score, all time points SF-12 PCS, 6 weeks/12 weeks/1 year/2 years SF-12 MCS, and 2 years VAS arm score (P ≤ 0.013, all). VAS neck preoperative score >8 had inferior PROMIS-PF scores all time points except 1 year (P ≤ 0.036, all), lower SF-12 PCS 6 weeks/6 months (P ≤ 0.043, both), inferior SF-12 MCS at preoperative to 6 months (P ≤ 006, all), higher VAS neck score from preoperative to 6 months (P ≤ 0.018), higher VAS arm score preoperative/12 weeks/6 months (P ≤ 0.020, all), and higher NDI at preoperative/12 weeks/6 months (P ≤ 0.030, all). MCID attainment rates for VAS neck preoperative score >8 were greater for NDI 2 years (P = 0.040), lower for PROMIS-PF score 2 years, and overall (P = 0.018), lower for SF-12 MCS 12 weeks (P = 0.046), lower for VAS neck score 12 weeks to 1 year and overall (P ≤ 0.032, all), and lower for VAS arm score 6 weeks/1 year (P ≤ 0.030, both). CONCLUSIONS Patients with single-level ACDF presenting with greater baseline neck pain showed poorer physical function/pain/disability/mental health at preoperative/intermediate postoperative time points, but had comparable long-term PROMs by 2 years. MCID attainment was lower among patients with greater preoperative neck pain; MCID among the VAS neck score >8 cohort were only significantly inferior for neck pain.
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Affiliation(s)
- Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kanhai S Amin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Siempis T, Prassas A, Alexiou GA, Voulgaris S, Tsitsopoulos PP. A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion. J Clin Neurosci 2022; 104:91-95. [PMID: 35987119 DOI: 10.1016/j.jocn.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion. METHODS A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale. RESULTS Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56-20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11-15,30%). CONCLUSION An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.
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Affiliation(s)
- Timoleon Siempis
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Aristeidis Prassas
- Department of Neurosurgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - George A Alexiou
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece.
| | - Spyridon Voulgaris
- Department of Neurosurgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Mental Health as a Predictor of Preoperative Expectations for Pain and Disability Following Lumbar Fusion. World Neurosurg 2022; 161:e401-e407. [DOI: 10.1016/j.wneu.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/22/2022]
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Influence of Preoperative 12-Item Short Form Mental Composite Score on Clinical Outcomes in an Isthmic Spondylolisthesis Population Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 158:e1022-e1030. [PMID: 34906755 DOI: 10.1016/j.wneu.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine preoperative 12-Item Short Form Health Survey (SF-12) Mental Component Summary (MCS) influence on minimally important clinical difference (MCID) and patient-reported outcome measures in patients with isthmic spondylolisthesis receiving minimally invasive transforaminal lumbar interbody fusion. METHODS Patients with isthmic spondylolisthesis undergoing primary, single-level minimally invasive transforaminal lumbar interbody fusion at L5-S1 were retrospectively identified and divided into preoperative SF-12 MCS <50 and SF-12 MCS ≥50 groups. Visual analog scale (VAS) back/leg, Oswestry Disability Index (ODI), SF-12 Physical Composite Score (PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were assessed. Improvements from preoperative score were analyzed via paired samples t test. Patient-reported outcome measures and MCID attainment between groups were evaluated using linear regression and χ2, respectively. RESULTS SF-12 MCS <50 and SF-12 MCS ≥50 groups included 35 and 26 patients, respectively. SF-12 MCS < 50 group had inferior scores for all VAS back time points except 6 weeks, all VAS leg time points except 6 weeks/1 year, all ODI time points, SF-12 PCS at 6 months/2 years, and PROMIS-PF at preoperative/6 months (all P ≤ 0.049). SF-12 MCS <50 group improved for VAS back/leg to 1 year, ODI and SF-12 PCS from 12 weeks to 1 year, and PROMIS-PF at 1 year only (all P ≤ 0.047). SF-12 MCS ≥50 group improved for VAS back from 12 weeks to 1 year, SF-12 PCS 6 months to 2 years, and VAS leg, ODI, and PROMIS-PF 12 weeks to 2 years (all P ≤ 0.018). MCID attainment differed for ODI at 6 weeks and PROMIS-PF at 12 weeks only (both P ≤ 0.035). CONCLUSIONS Patients with SF-12 MCS <50 demonstrated fewer long-term improvements from preoperative to 2 years and inferior patient-reported outcome measures at most time points for pain and disability following minimally invasive transforaminal lumbar interbody fusion. MCID attainment largely did not differ by preoperative mental functioning.
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